What is Developmental Language Disorder? Part 2

In this second part of our conversation with Dr. Jan Wasowicz, Dr. Wasowicz delves into what an ideal intervention for developmental language disorder would look like, how language screeners are no longer a common practice in schools, and how interprofessional collaboration between speech language pathologists, school psychologists, and special education teachers is essential to effectively identify and support students with language disorders. 

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A Review of Screeners to Identify Risk of Developmental Language Disorder

Transcript

Lauren Clouser:

Welcome to the LDA Podcast, a series by the Learning Disabilities Association of America. Our podcast is dedicated to exploring topics of interest to educators, individuals with learning disabilities, parents, and professionals to work towards our goal of creating a more equitable world. Thank you for joining us for part 2 of our conversation with Dr. Jan Wasowicz. If you haven't listened to the first part of our discussion, we recommend you go back and tune in.

Can we talk a little bit more about what an evidence based intervention for DLD should look like?

Jan Wasowicz:

So it's hard, I would basically have to download everything in my brain and in that time here, so I'll try to give at least one specific example. But let me talk just more generally first. What we're going to be teaching the students, of course, is to depend on their differential diagnosis and the specific areas. So just like in SLD, there are patterns of strengths and weaknesses. And in DLD, same thing. Syntax might be fine, vocabulary, not so fine. So we identify those, and we of course write our goals and target our intervention to that. It's rarely just one skill.

So we're simultaneously working on multiple skills. And so there's a real art and science to that because we've got to address them in a very integrated way. I sometimes say that when I'm doing interventions with my students, I feel like I'm the conductor of a linguistic orchestra. So I've got to get all the linguistic pieces coming together. I've got to queue this one, and then I've got to queue that one and bring them all together for my students. So there's that. By the way, something else you might want to put in your show notes related to that is I created an illustration a couple of years ago called the language literacy network. And it's an expansion on the reading rope because, as we know, the reading rope only covers reading.

So it covers both reading and writing, and it brings the illustration up to date to reflect current best practices. So the reading rope was published in 1992, and it hasn't been updated. And, of course, we have tons of new information, tons of new research. So the Language Literacy Network, you can put it in the show notes. It's freely available as a PDF. And it shows kind of what I mean, I'll even hold it. I know the people listening can't see it, but I just want to show it to you as it kind of shows what I mean when I talk about orchestrating. I'm bringing together all these linguistic components. I'm kind of in the middle and bringing that all together.

So, with that, what we're going to teach will, of course, depend on the specific need. The general progression is what you would typically see. So we're going to teach concrete nouns before abstract nouns. We're going to teach compound sentences before complex sentences. So that progression, it's all the same. And if there's a good ELA curriculum in place, that's what they're doing. So there isn't a whole lot of difference there. The difference gets into the how.

And we really need to, for these students, we need to break it down into what I call micro baby steps. Of course, it varies for each individual student. But we have to be ready and be prepared to break it down into micro baby steps. And, just kind of as an example. So all students need to learn narrative and story grammar with our character and our setting and our kickoff event and resolution and all of that. For your typical learner, it's fine to just talk about these things and then identify them in a story and then retell the story, and that can be fine. For any of our students who have learning challenges, this includes DLD, SLD, whatever. If they're struggling with telling a story, then starting to have visuals or manipulatives.

So there's something called the story grammar doll, and it has a head at the top to remind them about talking about the character. And then as you go down the body of the doll, it gets into the different story grammar elements, and there's a little heart to remind the storyteller to talk about internal states and feelings as a response. And then there are the beads for the sequence. So these kinds of visuals, laying it out, are really powerful and actually necessary for a lot of students. But even then, I have to go to the next step. So it's like, okay. But now we have to write the story or fill out a template. I can't just give my student a template with a character setting, you know, event, blah blah blah.

I've actually created that too. I've got to create visuals, little icons, and I have to give them the questions to ask to help them answer and fill in those components of the template. So I have to give them a question to ask so that when they fill in the part about the kickoff event, they ask the right question so that they get the right answer. And then you have cohesion. It helps them get the cohesion among the different elements and components of telling a story, which is often lacking. And these are the kinds of supports. Of course, we're going to gradually fade those, but these are the kinds of supports that they need. And then they've got to verbally rehearse and rehearse and rehearse, and then they've got to chunk and chunk and write.

So these are the baby steps. One example, there's, you know, a gazillion others, that have to be thought of and used to scaffold the individual student.

Lauren Clouser:

So talking a little bit more about the role of school-based SLPs, many school-based SLPs do not take an active role in terms of literacy intervention. And what do you see as the primary reasons for that?

Jan Wasowicz:

So I mentioned one already, which is that there are a fair number of SLPs who are not prepared at the higher ed level, and that's on our profession. That's not on them. It's just on our profession. But then if they're in the school setting, it's on them because they should take it on for additional training to make sure they build up their skills. But I want to talk about the ones that are qualified. There are a lot of really excellent SLPs in the school, so I don't want to diminish that. And they want to participate. Well, they fall into 2 categories.

They're either really well qualified and they want to participate or they don't. If they don't want to participate, it's because their caseloads are already too high. They can't possibly take on any more. That's usually the main reason. But most of them want to help. They want to help in whatever way they can. And we could help across the spectrum of services from consulting on the assessments to bringing better practices into the classroom. You know, language teachers don't know how to teach language.

So how can we bring some things into the classroom that can help all students and certainly help the students who have DLD? So they want to participate. And there are roadblocks, however. There are systems in place within schools and silos. This is a big one that I've been advocating for is to get out of our silos. And I gave at least one example earlier about SLPs doing speech and language. Let us do the language. You guys have your specialties. We have our specialties.

So let's bring our specialties together. Now that doesn't mean we stay in our silos doing our specialties. We're still collaborating. But I would say the biggest barrier is that the system's already in place. And that gets into a lack of awareness of what an SLP does, period. And then the lack of awareness about DLD and its impact on academics, even on social behavior in a classroom. So I think it's a lack of awareness. And then, of course, there's always budget issues, and schools have budgets.

And typically, SLPs will be among the highest paid specialists on the payroll. And so if you could have someone else do it and not pay him as much from an admin perspective...However, what they're not factoring in is maybe someone else can do it, but it's going to take longer or it's not going to be as effective. So those kinds of considerations need to be in place. But I've had an administrator of a large school district outside of Chicago, in fact, she was a special ed administrator. And we were talking, well, my company, but I was in that conversation. We were talking with the administrator about bringing in...they were going to be implementing our curriculum, SPELL-Links, and we're going to do the training. And we were talking about, when we come to do the training, first of all, the training was going to be with their special educators.

But we were advocating that they have at least one of them....we'd love to have all their SLPs there, but again, silos, systems, budgets, all that. But we were advocating very strongly for having at least one of their SLPs there. And, in fact, we know one who's very knowledgeable, and she'd be great, to be there as a facilitator for the training, but also to be there after the fact. So when the special ed teachers have questions, they have someone to go to about language. And the school admin said, well, we know SLPs are really important for working with the autistic children and stuttering, but we don't understand, she said, their role in language or in academics. So, I mean, we have a long way to go, and she was a relatively young professional just out of completing her doctoral studies. So we have a long way to go.

Lauren Clouser:

Yeah. Well, I feel like you addressed this pretty well already, but I wanted to give you the chance if you wanted to add anything to it, on just the collaborations between SLPs and school psychologists. I know you talked about the importance of them not overlapping, doing the same tests twice, and being allowed to specialize where they have the best knowledge. Is there anything you wanted to add to that?

Jan Wasowicz:

Yeah. And, yes, all of that is true. I would say what's also critical is that when it comes to the language testing, oftentimes the psych will do their testing, their standardized testing, and there's some language component in there. And they may come back and say there's a language disorder or not, but there's never enough information there in terms of what is the nature of the language disorder. What I oftentimes see is they will say there is no language disorder, and yet I go and do a full speech language evaluation, and there's all kinds of language issues. And the problem there is it's not on them per se. They're using standardized assessments. Standardized assessments aren't always going to be sensitive enough to pick up on these things that often go on.

We already know DLD is a hidden disorder. It doesn't show up easily. They aren't clinically trained in terms of what to observe, what to take in on a qualitative basis. And so they are likely to miss the areas. Or they might identify: well, this area in language was weak on my standardized test, but they're missing so many other areas just because that's how the test is designed. The test is really designed to see if the student is within normal limits or not, but it's not a standardized test. It's not going to dig into where they are falling apart.

Lauren Clouser:

So screening children in kindergarten for speech and language concerns used to be a common practice in US schools. Is this still the case? And if not, should it be? And, also, what would you recommend screening should consist of?

Jan Wasowicz:

So I'll show my age here. But many years ago, back when I was just out of college and working in the schools, yes, I went and screened every kiddo in that school. Absolutely. I could still picture sitting in the hallway and talking to them, and that's really what it was. You might have a checklist, back then, and it was a lot we just knew what to listen for, and it was a lot of qualitative kinds of observations. So is it common today? I don't think so. I mean, I have to say no. I'm hopeful, maybe.

I'd like to think maybe SLPs somewhere, somehow are doing it, but given budgets and caseloads and everything else, I don't believe speech language screening is the norm in the schools. So what can be done? Well, this is going back to the growing awareness about DLD, and along with that is the development of more and more screening tools, specifically for developmental language disorder. And, I'll give you afterward an article that you can put in your show notes as well. It's an open access article. It was in the American Journal of Speech Language Pathology in May of 2024.

And they review all the screeners available then. And, actually, if it was published in May of 2024, it was probably all the screeners available a year prior. But what they identified, the pros and cons, and I think they reviewed, I want to say 24 screeners, reviewed the pros and cons, and came up with 3 that they recommended as kind of the top. Now, again, this is whatever was available then, so there may be others. I know of at least one other one. So, specifically, the student language scale, which is a screener, and this was developed by Nikola Nelson. I mentioned her earlier with the quadrant model. And what's nice about this one is that it's a questionnaire.

It's a questionnaire that teachers or parents can administer. And I was at the IDA conference a couple of weeks ago in Dallas and went out to dinner with Dr. Nelson and we talked about getting this into pediatricians' offices too so that they can give it to the parent, and the parent can fill it out. And now we have a way to better screen outside of school. But it can easily be administered by teachers. And those who know about screeners is we have to look at their sensitivity and specificity scores. And the 3 that I'm going to mention here have good sensitivity and specificity scores, and I think that's why these three landed at the top. However, only that one that I just mentioned is a questionnaire, so it can be administered easily by the teacher or the parent. The other 2 that made the top of their list are tools that would require some type of professional qualification, psych, you know, SLP, whatever the qualification is.

And that would be the CELF 5 has a screening component. So that's the clinical evaluation of language fundamentals, I think, 5. We're so used to the acronyms. So the CELF 5 screening and then the PLS, the Preschool Language Scale, PLS 5 screener. And of course, that one is just for preschool. The CELF 5 goes into older grades. So those are also identified as good screeners. And, again, there is this movement to start to do more universal screening for DLD.

Now the kinds of things that these different tests look at or even what I might look, or what I did look at when I sat in the hallway with the students, you know, I'm looking for their vocabulary usage. I'm looking for their length of sentences and how complex those sentences are, so syntax. I will ask them, this is a good one, to repeat words and repeat sentences, and that can usually be quick and dirty...Repeating a sentence, if they're struggling there, that's usually a really quick and easy way to say: I need to dig a little deeper. And then just their understanding of what I say to them. Word finding. Again, that's a unique indicator, and their storytelling, whether it makes sense, it's cohesive, it's organized, those kinds of things.

And those are the kinds of skills that are typically looked at in these screeners. Now one caveat I want to put on screening is, this is just an example, there is a screener. It's called the Cubed 3, and I cannot remember what cubed stands for, but cube like a shape cube. It does narrative screening. So it's great to help tease out what I just said about telling a story, and is there cohesion, and are all the story grammar elements there. And it's really a great screener. However, it looks at some ability to learn vocabulary after they listen to a story.

So it's getting into some of those other language components. It doesn't at all consider, at least in its current form, it doesn't consider syntax. So a student can pass that screener, and it's a screener used by classroom teachers. So, yay, but they can pass it and not have syntax errors that a typical classroom teacher is not going to know whether they're typical or atypical syntax errors. And syntax errors are one of the stronger flags for DLD. So these kids might say, oh, everything's fine. Language is fine, and it isn't. So here's another example of why we all need to be out of our silos, and we need SLPs consulting with classroom teachers, special ed consulting with SLP, and vice versa.

I mean, we all just need to work together because none of us, myself included, has all the knowledge and skills we need to help our students.

Lauren Clouser:

I think that's a really great point. So Dr. Wasowicz, thank you so much for spending the time, this is such an informative episode, and I really appreciate your time on this. Before I let you go, I just wanted to see if there was anything that maybe we didn't ask that you wanted to add.

Jan Wasowicz:

Well, thank you. Thank you. And again, going back to the getting out of silos, I want to invite everyone who's listening to join SPELLTalk. The reason I created SPELLTalk, it's a listserv, and again, it's free. And I think we're in our 18th year. I can't remember. And we have members from around the world, mostly the US, of course. But it's multidisciplinary, and I created it to be that way because, again, getting out of silos.

As an SLP, we have our own listservs. We have one for every area of specialty. So I had been on this listserv for so many years, which was wonderful, but it was a bunch of SLPs talking to a bunch of SLPs. And I thought there's got to be something that gets us talking. Now, this goes back 18 years or whatever. And so, obviously, there weren't as many social media opportunities. But even then, I think there are still some silos out there.

So I just want to maybe close on inviting everyone to join SPELLTALK. It really is about these interprofessional collaborations, as well as just being knowledgeable and staying up to date with current best practices. And specific to developmental language disorder, Dr. Tiffany Hogan is one of the experts in this area. She's a member. She recently has very recently posted about DLD. It's a great way to hear good content from the experts. Dr. Berninger is on there, although she's pretty well retired.

Nikola Nelson is on there. Tiffany Hogan, and they're all sharing their knowledge and expertise. So please join. We'll get it in the show notes. And, again, Lauren and Monica, thank you for this opportunity.

Lauren Clouser:

Thank you for listening to the LDA Podcast. To learn more about LDA and to get valuable resources and support, visit ldaamerica.org.